Author: Rachael Severance

Trauma-Specific Self-Care: Part 1

Self-care is important for everyone. But how do you practice self-care and self-compassion when you have been through or are currently experiencing a traumatic life event? In this first of a two-part series on trauma-specific self-care, we look at how your body responds to stress and trauma and what individuals can do to begin healing.

What Determines my Level of Tolerance?

We all have different ranges of tolerance to life’s stressors. The ideal state of being in which you have the ability to deal with life’s ups and downs to a reasonable extent is what the National Institute for the Clinical Application of Behavioral Medicine refers to as your “window of tolerance.” Stress and trauma affect your window of tolerance, shrinking it and disturbing what stresses you’re able to handle. You may become hyperaroused—anxious, angry, overwhelmed—or hypoaroused—zoned out, numb, frozen. These reactions aren’t something you choose; it’s simply how your body reacts. Working with a mental health provider can help you by expanding your window of tolerance, so you have a wider range of situations and challenges you are able to cope with.

How Is my Body Affected by Stress?

Traumatic stress is experienced in the body. Upon noticing something novel, you become alert. You then move into threat identification, seeking social cues to evaluate the extent of the threat. Both the alert and the subsequent shift into threat identification are instinctual responses to your environment, and you may not even be conscious of them. If you perceive the novel event as a threat, whether real or imagined, your body is then aroused—your lower, reptilian brain takes over, and your threat-defense system is activated. This process sends adrenaline, cortisol, and oxytocin into your body. You then experience a defense response: fight, flight, freeze, or tend and befriend. If your defense response works, your body calms down and your upper or cortex brain begins processing the experience.

In a state of alert, your body becomes hypersensitive, with a particular heightened awareness of the real or perceived threat. You can experience hyperarousal when trauma associations are triggered, feeling a flood of emotions such as anxiety, fear, anger, and grief. Trauma expert and Simmons College Graduate School of Social Work professor Julia Colpitts, MSW, calls this state “stuck on.” Or, you can experience hypoarousal, where you distance yourself from emotions to quiet the state of hyperarousal, which can lead to numbness and a disconnection. Colpitts calls this state “stuck off.” Your arousal responses highjack your higher brain functions and create physical reactions.

When stress and trauma are complex or ongoing, your body does not return to its baseline, and this sort of constant hypervigilance and arousal flood your body with stress hormones, which can impact health. Physical reactions can range from simple tension to chronic illness. Often, those who experience trauma will develop behavioral patterns to manage traumatic arousal. These behaviors often involve food, alcohol, inactivity, or overwork, which can provide short-term relief but cause long-term negative consequences.

How Can I Heal from Stress and Trauma?

Calm the body, calm the mind. Self-compassion involves enacting a lesser-used cycle of emotional regulation, which Paul Gilbert calls the “soothing system” in his book The Compassionate Mind: A New Approach to Life’s Challenges. The soothing system, which manages functions to slow down, soothe, rest and digest, safeness, kindness, and care, can be underdeveloped in an individual. With practice, you can build upon it to better manage your emotions and expand your window of tolerance.

What is a Resiliency Toolkit?

To strengthen your soothing system, spend more time in self-compassionate practices that center physiological and mind-body relaxation. Focus on creating a personalized relaxation practice from a menu of soothing options, Colpitts advises. Some soothing strategies to add to your resiliency toolkit include:

  • Breathwork, such as box breathing
  • Muscle tension release using progressive relaxation techniques
  • Guided meditation, such as those offered by Kristen Neff
  • Sensory stimulation (e.g., aromatherapy, calming visuals, nature sounds, savory tastes, touch, water, sexual activity, massage, Reiki bodywork, and grounding strategies)
  • Acupressure and acupuncture
  • Yoga, tai chi, and other mind-body centering work
  • Self-compassionate meditation and activities, such as bilateral stimulation like the butterfly hug, and affirmations
  • Interacting with animals, including equine-facilitated therapy
  • Mindfulness and related physical practices, such as walking meditation and forest bathing
  • Body scans
  • Expressing gratitude and love

Try to maintain a regular practice of your chosen relaxation techniques. You can form healthy habits by starting small and attaching a technique to part of your regular routine, such as breathwork after brushing your teeth each day. Take note of the improvements you feel, which will help you continue and build upon your emotional resiliency menu of options. By regularly employing direct body and other relaxation strategies, your body will calm down and your mind will follow suit. This will create patterns of calm that serve to “release stored arousal and reestablish a peaceful baseline,” according to Colpitts. “The more strategies you use,” she states, “the more difference it will make.”

What Else Can I Do to Take Care of Myself after Trauma?

In addition to using tools in your resiliency toolkit, you can also “burn off” the stress in your body from traumatic experiences by engaging in physical activity. This can include energetic pursuits, such as dancing and working out, and/or more soothing activities like hiking and listening to music.

You may also need strategies to depower your threat defense system, which for those who have experienced or are experiencing trauma is overactive. You can do this by partnering with a mental health professional to learn new patterns and activate the care system. We also advise working with a practitioner on cognitive behavioral work and to engage with trauma success factors, including taking reparative action, interrupting the trauma flow, managing arousal, bringing attention to cognitive adaptive patterns, cultivating positive attachment and experiences, and attending to context.

“Being kind to ourselves releases energy to move forward,” Colpitts says. And it “soothes body, mind, and spirit.”

Thank you to Julia Colpitts, MSW, for sharing her keynote presentation and ideas on this subject.

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Posted on by Author Rachael Severancein Categories News

How Do I Help Students Concerned about School Violence?

As summer comes to a close, parents and students across America start preparing to head back to school. Some students understandably have anxiety about returning to the classroom in light of the school shooting in Uvalde, Texas, and other recent incidents of school shootings. How can we help children who feel anxious about school violence? Let’s look at ways back-to-school anxiety is expressed and examine strategies for helping students with concerns about school violence.

What are Signs of Anxiety in Children?

Anxiety over school shootings has become common in America. Even when children aren’t directly involved in episodes of school violence, they are deeply affected by these traumatic experiences. Exposure to violence can cause learning and behavioral problems in students. Children may feel anxious or fearful, and they may not express the distress they are feeling in a way that adults can easily recognize.

If a child isn’t directly communicating their worries about returning to school, look for symptoms that may indicate anxiety is present. These signs can include:

  • Excessive worry
  • Seeks constant reassurance from teachers and caregivers
  • Avoids school or summer camp
  • Sadness/depression
  • Withdrawn
  • Difficulty enjoying activities that were previously pleasurable
  • Irritability/anger
  • Argumentative
  • Negative thinking patterns
  • Hypervigilance
  • Difficulty concentrating
  • Poor or declining school performance
  • Poor appetite
  • Headaches
  • Nightmares

How Can I Help Anxious Students?

The most important way you can help school-age children coping with anxiety around school violence is to talk to them. Do not avoid the scary topic—that makes it scarier. Ask them what they are thinking and feeling. Listen attentively, and use the information you gather as a basis for how much information they need and can handle, in addition to the child’s age and whether or not they have experienced trauma before.

Children’s concerns and questions tend to be different than adults’. Kids often want to know who is to blame, what could be done to prevent the tragedy, or whether it could happen at their school. Being truthful in your response—while keeping in mind developmental appropriateness—is crucial to building and maintaining trust and open communication with the child.

Validate the child’s feelings. Avoid downplaying their concerns or fears. And keep the conversation going—this is not a one and done talk, and it might be best to handle in smaller doses, especially for younger children. An open-door policy and a continued dialogue encourage children to share their concerns at any time.

Anxious kids also benefit from routines. Keep schedules predictable to the extent you are able. The consistency of their daily routine will help them feel secure and safe.

Limit their exposure to violence. While we want to keep an open, honest dialogue, seeing the same event televised or in the papers repeatedly is not helpful and may in fact be harmful. This can mean developing new household rules to limit screen time or access to newspapers and/or social media, especially after a school shooting or other traumatic event.

For parents, caregivers, and therapists of older kids, such as those in middle school or high school, we can help them convert anxious or angry feelings into plans for action. Older students may find that becoming an advocate for school safety helps them channel their anxiety into action, creating a helpful, healthy coping strategy for dealing with feelings around school violence. Also encourage them to report specific incidents that concern them, such as bullying or threats, and occasionally check in about how they are feeling or what they are experiencing at school.

Finally, as an adult, manage your own anxiety around school shootings. Kids are very adept at picking up on their parents’ fears, which can contribute to increasing the intensity of their own fears. To reassure a child, you need to be taking care of yourself, too. Ensure you have another adult to talk to about how you feel, de-stress, and engage in regular acts of self-care. When you model healthy ways to cope with stress and fear, children will learn from that behavior. Ultimately, we want to teach children skills for self-soothing and effective, lifelong coping mechanisms in dealing with stressful events to develop their resiliency for all they might encounter.

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How to Identify and Treat Summer Depression

Summertime… and the living isn’t easy for everyone. Depression in the summer is more common than you might guess. While many equate summer with school vacation, outdoor camps, water fun, and blooming gardens, others can and do feel depressed during the sunny season—and the social expectation that you’re supposed to have fun can make that depression feel even lonelier and more isolating.

How to Identify Summer Depression

While summer depression shares common symptoms with depression (feeling depressed most of the day, having low energy levels, losing interest in activities you used to enjoy, difficulty concentrating on tasks, and feeling hopeless or worthless), summer depression has specific symptoms that include:

  • agitation and restlessness
  • loss of appetite
  • trouble sleeping (insomnia)
  • weight loss
  • anxiety

If you feel depressed come June each year and it seems to improve around September, you may be experiencing summer depression. The National Institute of Mental Health indicates a patient may be diagnosed with summertime seasonal affective disorder if they have symptoms of major depression, have lived with depressive episodes in the summer months for two consecutive years, and have a tendency to have depressive periods more frequently in the summer than in than in other times of the year.

Symptoms of summertime blues, by contrast, are similar (low mood and a lack of energy) but less debilitating.

Where Does Summer Depression Come From?

Like all forms of depression, summertime depression can have biological, psychological, and/or environmental causes. Summer schedules are often disruptive to our usual schedules, and this sudden, big change can be hard to handle, especially for people who are vulnerable to depression.

Biologically, some studies suggest that, like other forms of major depressive disorder (MDD), summer depression may be linked to the brain chemical serotonin. The risk of developing summer depression is higher for women, those with relatives with a mental illness, or those who have major depressive disorder, bipolar disorder, or another mental illness.

More than 3 million American adults experience seasonal affective disorder, or SAD. Of those, about 10% of people who have a MDD with a seasonal pattern, such as SAD, have their depression symptoms begin at the onset of summer, not winter. It’s unclear why this happens to a subset of those with MDD or SAD. Some experts point to too much sunlight, heat, and humidity as possible culprits.

How to Help Your Clients Cope with Summertime Depression

A number of tools and strategies can be employed by mental health practitioners to help their clients cope with summer depression.

  • Change dosage. If you are licensed to prescribe medications, consider temporarily increasing the dosage of your client’s medication for depression. Or, if you are not, encourage your client to speak to their medication prescriber about gradually increasing their dosage in late spring and easing off slowly in the fall.
  • Respect the worry your client may be feeling. With summer depression in particular, people who are struggling with their mental health are apt to feel something is wrong with them: Why does it seem like everyone else is having fun and I’m not? What’s wrong with me? While this is a typical response, it is not helpful to compare how we’re feeling with how we think we’re supposed to feel. Instead, gently encourage your client to focus on the causes of their summertime depression and how it can be resolved.
  • Evaluate triggers. Consider what past experiences your client may be associating with summer, whether it’s the death of a loved one, an important anniversary, or another traumatic event. Working through triggers may lessen or release some of these associations.
  • Experiment with darkened rooms. Following some mental health professionals’ theory that too much sunlight could be causing summer-onset MDD, spending more time in darkened rooms—the opposite of light therapy—may be advisable. For similar reasons, wearing sunglasses may help.
  • Advocate for regular exercise. Numerous studies demonstrate that regular physical activity can help depression and mood disorders.
  • Recommend a good night’s sleep. Insufficient sleep can trigger depression. Rule out this cause by ensuring your client is getting enough ZZZs (generally 7 to 9 hours a night for adults).
  • Engage in mindfulness. Yes, there’s that oft-mentioned recommendation to develop a meditation and mindfulness practice again! Evidence shows mindfulness has a significant impact on mental wellbeing, combating fatigue and naturally bolstering one’s defenses against depression.

Get Help

If you or someone you know thinks they might be depressed, regardless of the time of year, please get help. Do not take summer depression lightly or downplay its symptoms. Talk to a mental health practitioner. We are here to help, and there are effective treatments available. You do not need to suffer in the summer.

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Together for Mental Health

More than 52 million American adults—or one in five—live with a mental health issue. Despite its prevalence, we hold an unhealthy stigma of mental illness. As a result, some individuals who live with mental health issues experience challenges accessing quality care and coverage, a challenge that can be exacerbated by their backgrounds and identities. This needs to change.

Reducing the stigma associated with mental illness is central to Health Affiliates Maine’s vision. By recognizing that we are all affected by mental health and substance issues, we reduce the stigma associated with accessing care, and in doing so, we increase the opportunity for everyone to participate in their own journey to wellness.

That’s why we’re proud to raise awareness for the Bebe Moore Campbell National Minority Mental Health Awareness Month this July. “Together for Mental Health,” we proudly stand up for a shared vision of a nation where anyone affected by mental illness—no matter their class, culture, ethnicity, or identity—can get the appropriate, quality care and support they need to live healthy lives.

“We need a national campaign to destigmatize mental illness, especially one targeted toward African Americans…It’s not shameful to have a mental illness. Get treatment. Recovery is possible.” –Bebe Moore Campbell, 2005

 

Anyone can experience the challenges of mental illness. Mental health conditions do not discriminate based on race, color, gender, class, sexual orientation, or any other elements of our identity. While BIPOC have rates of mental health disorders similar to white people, people in the BIPOC community are disproportionately affected by a lack of access to quality healthcare and cultural stigma, according to US News.

Of the 52 million+ Americans who live with a mental health condition, nearly 5 million are black people—and yet only 33% of those seek appropriate treatment, such as regularly meeting with a mental health professional, compared to nearly half of white people. As writer and policy analyst Brakeyshia R. Samms describes, there are many factors that contribute to whether or not a person with a mental illness receives treatment, including under/misdiagnosis, lack of access to quality care, and community stigma. We all experience these factors, but some communities experience them to a disproportionate degree—and suffer as a result. Bebe Moore Campbell summarized the issue: “No one wants to say, ‘I’m not in control of my mind.’ But people of color really don’t want to say it because we already feel stigmatized by virtue of skin color or eye shape or accent, and we don’t want any more reasons for anyone to say, ‘You’re not good enough.’”

How to Help

Samms suggests four activities we can all engage in to take action against the stigma around mental illness: gather information to counter “negative preconceived notions,” speak up, remain open, and believe people. “Stigma stems from a lack of knowledge,” Samms writes, “and the best way to fight a gap in information is by educating others in our community.” To this end, understanding and then communicating the complex issues at play helps spread acceptance and inclusivity, which in turn fights the inequities and stigma we have developed and now need to unlearn as a culture.

 

Sources: www.nimh.nih.gov, nami.org, rtor.org, mhanational.org

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Restore Your Mental Health: Forest Bathing in Maine

You’re in the middle of a forest on a beautiful day in Maine. Sunshine peeks through the leaves and scatters in fascinating, eye-catching patterns on the moss-covered ground, soft under your feet. You breathe in the scent of pine and become aware of the stillness and the small sounds of scurrying chipmunks and birdsong echoing across the land. Green leaves, brown soil, and glimpses of blue sky fill your vision for as far as you can see. Warmth from the sun spreads across your face. You can feel your whole body relax as you walk slowly through the woods, breathing and sensing each moment fully.

Immersing ourselves in nature cultivates a sense of mindfulness, a practice that is now widely known for promoting mental wellbeing. What is it about being outside that restores us so?

Many workers spend hours indoors in a busy state of focused concentration, and one of the results can be mental and physical fatigue. Fatigue and stress are risk factors for depression, as is the lack of vitamin D many of us experience during Maine’s long winters. Treatment for mild to moderate depression may include cognitive behavior therapy (CBT) and other interpersonal therapies. Many also find strategies such as aerobic exercise, yoga, and the Japanese practice of forest bathing helpful, whether they are experiencing mild depressive symptoms or simply daily stressors.

In addition to sometimes leading to depression, fatigue can result in reduced attention, and forest bathing seems to provide a respite from the long hours of concentration that typical workdays require. Screentime, a modern near-requisite, can exacerbate the problem, as can urban living and spending much of our time indoors.

In psychological parlance, Stephen Kaplan’s theory of attention restoration proposes that when we use quite a bit of directed attention, or effortful attention employed to focus on a task we’re choosing to pay attention to, we need to exercise involuntary attention, which naturally occurs in nature, to restore our balance. Directed attention, in other words, such as you employ during the workday, can cause fatigue and mental exhaustion (even if you enjoy the work you are doing), and you need regular breaks to offset the effects.

Research has demonstrated that the Japanese practice of Shinrin-yoku, or “forest bathing,” has positive physiological and psychological benefits, including a reduction in blood pressure, an improved immune system, and improved mental health—and one study in particular, published in Environmental Health and Preventive Medicine in 2019, found the improved state of mental health especially pronounced for those with depressive tendencies. This natural remedy for mild depressive symptoms can alleviate negative emotions and moods such as anxiety, fear, anger, and disgust, and increase positive emotions such as joy.

Since a number of studies in the 1980s touting the benefits of Shinrin-yoku, Japanese doctors have included the practice, which they often describe as preventative medicine, in what is called “social prescribing.” Other social prescriptions include gardening, mountain walking, exercise and sports, swimming, caring for animals, and cooking—all activities, you may note, which engage our senses.

To practice forest bathing, we can fully immerse ourselves and our senses in a walk in the forest. Put away your phone. Slow down. Quiet your mind. Notice the details from all of your senses. It is not as simple as taking a walk outside; “immersion” is precisely the right word to truly experience all of Shinrin-yoku’s benefits. And if you don’t have access to a forest, parks can serve as a substitute space.

More research is needed to fully explore the therapeutic aspects of Shinrin-yoku, including studying whether its effects apply to those with high stress and depressive tendencies. In the meantime, forest bathing can be a stress-reducing, preventative, healthy outdoor activity for everyone to enjoy—and summer in Maine is a great time to try it out.

 

Sources: psychologytoday.com, ncbi.nlm.nih.gov, mentalhealthtoday.co.uk

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Psychological Flexibility: Flexing Your Thinking to Improve Your Wellbeing

Many things happen in our lives that we cannot control or predict. Unexpected, large-scale traumatic events like the COVID-19 pandemic and the invasion of Ukraine can be sources of stress, as can daily life stressors, such as conflicts in relationships, money troubles, or an upsetting interaction. Psychological flexibility, or the ability to adapt our thinking and behavior when new or unexpected events arise, is an important skill we can use to increase individual wellbeing now and in the future.

Let’s say you are being tailgated by an aggressive driver on a two-lane highway. You feel scared and worried about what will happen if you need to use your brakes. No one is around to help.

Employing psychological flexibility in a given situation can be seen as a three-stage sequence of events:

  1. Evaluating the needs and demands of the situation or context;
  2. Selecting a response or coping strategy; and
  3. Monitoring the success of the approach you employ and modifying it as needed.

In the example we illustrated above, where the stressor was a tailgater, this sequence might look like:
Context sensitivity = There is potential for danger here. You need to remove yourself from its threat. The other driver may not react quickly enough if you brake.
Repertoire = Continue going the exact same speed and be extra alert for the possibility of needing to brake.
Feedback = You feel stressed and scared. You still don’t feel safe. They have not stopped driving too closely to your car.

You may then decide, from the feedback loop, to modify your approach and select a new behavior in your repertoire. Perhaps you can use your right turn signal to indicate you would like them to pass you, for instance. The feedback loop can continue until you have met your goals for the situation.

This sort of flexible thinking, as you might imagine, is a predictor of resiliency and creativity. Research shows psychological flexibility is associated with a better quality of life, particularly in older adults. In the workplace, exercising flexible thinking tends to lead to better job performance, improved learning on the job, innovation, and better overall mental health, including lower levels of stress and emotional exhaustion. In clinical settings, psychological flexibility training has been shown as effective in treating a myriad of disorders, such as anxiety, depression, and substance use, and this training works whether it is delivered in person or online.

The great news is psychological flexibility can be practiced and improved. But how?

Create optimal conditions for being flexible. By practicing mindfulness, doing yoga and aerobics, and engaging in relaxation techniques, we give ourselves a solid foundation to deal with stress in a purposeful, thoughtful manner.

Cultivate optimism. Rather than focusing on what the pandemic has negatively impacted in our lives, for instance, we can reframe our thinking and consider what has made us change for the better. Choose to view your struggles as part of being human, rather than something that happens to you.

Pause. Focus on your reactions and attitudes. What are you feeling? Why might you be
feeling this way? Allow yourself the space you need for an intentional response.

Exercise creative thinking. Consider unusual solutions. Seek outside perspectives. Frame issues from different angles. Challenge your own beliefs. By utilizing divergent thinking, we can overcome embedded thought patterns and see the situation from a new angle, which could provide a fresh perspective on the matter.

Keep your decisions aligned with your values. When you use your core values to guide your decisions, you gain peace of mind by keeping your integrity intact. At the same time, our values can change over time, and some situations present an opportunity to reflect on and evaluate which values are true for us and which may need to be reconsidered.

In clinical settings, we can employ cognitive behavioral therapy (CBT) as well as structure learning, or the ability to extract information about the structure of a complex environment and decipher streams of sensory information, to promote psychological flexibility.

Psychological flexibility helps us see that what we’re doing in response to a given stressor is not leading to a successful outcome, and it shows us how to make the appropriate changes to our behavior to achieve our goal. It is a handy tool in our kit to cope with stress. The more we exercise flexible thinking, the stronger it gets, providing us with a protective buffer between everyday stressors and possible negative outcomes.

 

 

Sources: ethicalsystems.org, psychologytoday.com, weforum.org

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